oh pr-04 referral for evaluation · • option #1 – create a new referral. click the radio button...

OH: PR-04 – Referral for Evaluation

SunGard K-12 Education Copyright © 2013 of 13

Last Modified: 6/4/2013

Ohio

Form OP-4: Referral for Evaluation

IEPPLUS




TABLE OF CONTENTS

OVERVIEW ............................................................................................................................................................................................ 3

FORM INSTRUCTIONS ....................................................................................................................................................................... 3

FORM CREATION ..................................................................................................................................................................................................... 3

Step 1 – Select A Student ............................................................................................................................................................................ 3

Step 2 – Select Options ................................................................................................................................................................................ 4

NAVIGATION/TOOLBAR ......................................................................................................................................................................................... 4

CODE TABLE SETUP ................................................................................................................................................................................................ 5

DATA MAPPING................................................................................................................................................................................... 8

‘MAIN’ SECTION ....................................................................................................................................................................................................... 8

‘EDUCATIONAL HISTORY’ SECTION ...................................................................................................................................................................... 9

‘BACKGROUND INFORMATION’ SECTION ........................................................................................................................................................... 10

REVISION HISTORY: ........................................................................................................................................................................ 13




OVERVIEW

The Referral for Evaluation form is a document that documents information for a student that is being referred to

Special Education such as demographic information, date of the referral (the form create a Referral Record in

IEPPLUS), date of parental consent, education information and health information.

FORM INSTRUCTIONS

FORM CREATION

The form creation process includes the following steps:

Step 1: Select a Student

Step 2: Select Options

STEP 1 – SELECT A STUDENT

1. Click Student Management > Manage an Existing Student.

2. Use the Search window to find the student based on either, Last Name, First Name or Student ID.

3. Click Search. Then click the appropriate Name to select a student.

4. Once a student has been selected, the student’s name, student ID, birth date, and age will display. The

forms that can be created for a student will also be listed. Click on the ‘Referral for Evaluation’ link.

The ‘Referral for Evaluation Summary’ screen will display, listing any prior forms created for the student. The most

recent form will display at the top of the list. To review an existing form, click the appropriate link. To create a new

form, click the ‘New’ icon.




STEP 2 – SELECT OPTIONS

1. When the ‘New’ button is selected (see screenshot above), the Form Wizard displays. This wizard is an

automatic template that helps the user to easily setup the form (see screenshot below).

2. There are 2 options to create the form:

• Option #1 – Create a new Referral. Click the radio button to the left of this option, enter a new

Referral Date, and select a Referral Type.

• Option #2 – Select an existing Referral. Click the radio button to the left of this option, and select an

existing Referral record from the drop-down box.

3. Select a Letterhead (optional).

4. When done, click the “Create Form” link. The user also has the option to click ‘Cancel’ as well to clear the

form. If this is chosen, then the form wizard will return the user back to the ‘Referral for Evaluation

Summary’ screen.

NAVIGATION/TOOLBAR

Once the form has been created, it will display a toolbar on the left side of the screen, divided into the following

areas:

1. Sections

This displays the Main, Educational History, Background Information, and View All sections of the form.

Clicking on any one of these sections will bring the user to that specific section.

2. Maintenance

These options will maintain Form Information, and Delete.

Form Information provides the ability to change the Form Name, Form Date Range, Letterhead, and

Referral. Delete functionality is available, depending on the user’s security.




3. Validation

These options will change the status of the form (Ready for Review, Lock, and Finalize).

4. File Attachments

Click the plus icon (+) to add an attachment. Click the minus icon to delete an attachment.

5. Archives

Archives are permanent PDF copies of the form. Click Finalize in the Validation section to create an

Archived copy. The form should be finalized and archived only after it has been fully completed and a copy

has been sent home to the student’s parents or guardians.

The following options will always display at the top and bottom of the form:

• Save

Information from each section should be saved before moving to another section.

• Return

Click the Return icon to return to the Form Summary screen.

• Print Preview

Print Preview will display the form in Adobe Acrobat. Mouse over the bottom of the form preview to see the

toolbar illustrated below. Select the Print icon or click the Save icon to save a copy of the form to your

computer. The plus (+) icon will enlarge the preview for ease of viewing.

CODE TABLE SETUP

1. Navigate to Maintenance > Manage Code Tables.

2. Select the name of the table from the drop down list (ex: “Referral Reason”).




3. To add a code, choose the ‘New’ icon from the top menu.

4. Enter the Description in the yellow box, then click on the ‘Update’ link, and then click the ‘Save’ icon from

the top menu.

5. To add or edit an Alternate Code, first click ‘Show Alternate Codes’ at the top of the page. Then click Edit on

the applicable Code record to open the record for changes.




Once the record is open, click the appropriate link to add a new Alternate Code or Edit an existing one. Clicking the

‘Delete’ icon will remove an existing Alternate Code. When finished with the changes, click the ‘Save’ icon.




DATA MAPPING

‘MAIN’ SECTION

1

2-3

4

5

6

7

8

9

10

11

12

13

14

14a

14b

14c

A




‘EDUCATIONAL HISTORY’ SECTION

15

16

17

18

19

20

21

22




‘BACKGROUND INFORMATION’ SECTION

23

24

25

26

27

28

29

30




IEPPLUS

OH: Form PR-04 – Referral For Evaluation

A Letterhead Maintenance, Manage Letterheads

• Use Options, Set System-wide OR My Options defaults

• Include Report Headers 1 & 2

• Form Date

• Footer on every page

Section: Main

1 Student Name Student, Demographic, Name

• First, Middle, Last name, Qualifier

2-3 Student Address Student, Basic Information, Address, Home

• Street, City, State, ZIP Code

4 Date of Birth Student, Demographics, Birth Date

4 Student Phone Student, Basic Information, Communication

5 ID Number Student, Demographics, Student ID

6 Gender Student, Demographics, Gender

7 Grade Student, Enrollment, Grade (as of Referral Date)

8 Building Student, Enrollment, Location (as of Referral Date)

9 Present Teacher(s) Multiple staff lookup and free-form text

10 Student’s Native Language Student, Basic Information, Demographics, Language

• If not = English, then displays language

11 Parent’s Native Language Student, Basic Information, Contacts, Parent/Guardian, Language

• If not = English, then displays language

12 Parent/Guardian/Surrogate

Information

Student, Basic Information, Contacts, Type = Parent, Guardian, or

Surrogate.

• Name, Street, City, State, ZIP Code

13 Communications Student, Basic Information, Contacts, Communications

• Home Phone, Work Phone, Cell Phone, Email, etc.

14 Reason for Referral Select from Student, Referral, Reason(s) = Alt Code = ‘IR’

• Enable text box and/or display text previously entered for this

referral.

• Referral Notes not entered through the webform will come

into the form.

• Upon saving in the form (or user will remove), it will be saved

with ‘Referral Reason’

14a Receive Consent Yes / No question.

• Enables Referral Consent Date and Outcome Fields

• This field does not print on the report

14b Consent Date Date Field

• Saves data to Referral Consent Date field


14c Consent Outcome Referral Result/Outcome drop-down.

• Saves data to Referral Outcome field.


Section: Educational History

15 Progress Data Text box

16 Intervention Data Text box

17 Trend Data Text box

18 Number of Districts attended Number field

19 Years at present building Number Field




20 Schools, earyl childood

Programs, and dates

Text Box

21 Attendance Check Box Control

22 Age-Appropriate Grade Level Yes / No Check Box Control

Section: Background Information

23 Health Data Check Boxes: Vision and/or Hearing

Check Boxes: Glasses and/or Hearing Aid(s)

24 Health/Developmental/Physical Check Boxes (Yes/No)

25 Environmental Factors Text Box

26 Preschool Only Check Boxes:

• Eating

• Dressing

• Toileting

• Attention

• Receptive Communication

• Expressive Communication

• Hearing

• Cognitive

• Fine Motor

• Play

• Gross Motor

• Vision

• Social/Emotional Behavior

• Other

27 Pertinent Inforamtion Text box

28 Signatures: Person Initiating

Referral

Text box becomes drop-down list if existing staff record is available.

29 Signatures:

Position/Relationship to

Student

Drop-down box for position/relationship selection. If existing

position is selected (field #28 above), it will automatically fill the

position. If no position is found, then the user can select any position

from the drop-down list.

30 Signatures: Date Form Start Date

User is able to change the date on the form if needed.




REVISION HISTORY:

6/3/2013:

• Updated entire document’s formatting to conform to standard SunGard QA documentation layouts.

• Added: ‘Overview’ section, ‘Form Instructions’ section, ‘Navigation/Toolbar’ section, ‘Code Table Setup’

section, cover page, table of contents, header, footer, and section breaks.

• Updated: Screenshots, and ‘Data Mapping’ section & table.

6/21/2011:

• Addition of Receive Consent, Consent Date & Outcome to Main page of this form. It does not print on the

report.

oh pr-04 referral for evaluation · • option #1 – create a new referral. click the radio button...

Documents